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Successful Appeal of a Terminated Disability Claim with Reliance Standard Life Ins. Co.

October 28, 2014

It’s been a busy year around the offices of McDermott Law, LLC, submitting many internal appeals to insurance companies which have inappropriately denied or terminated long-term disability (LTD) insurance claims.  We have several experienced several successful results lately, including a reinstatement of a terminated long-term disability claim a woman with chronic back and neck pain.  Ms. G suffers from lumbar radiculopathy, degenerative disk disease, cervical spondylosis and cervical radiculopathy.  Ms. G underwent fusion of the vertebrae in her neck which was followed by complications of Deep Vein Thrombosis and Pulmonary Embolism.  Ms. G has continued to suffer debilitating pain in her neck and lower back, radiating into her lower extremities.  Ultimately, the significant pain and surgical complications rendered Ms. G unable to perform the duties of her own occupation, prompting her to submit a claim for long-term disability benefits with Reliance Standard Life Insurance Company (RSL). 

Reliance Standard initially approved Ms. G’s claim and then shortly thereafter terminated benefits, so she contacted our office to assist her in preparing an appeal of her denial.  Similar to most claims we see, here was governed by the Employee Retirement Income Security Act (“ERISA”).  Our office was successful in convincing RSL that its original decision was incorrect; RSL has reinstated Ms. G’s long-term disability benefits.

In terminating Ms. G’s benefits, RSL relied upon a job description, which was not the actual position that Ms. G held with her employer.  We successfully argued how RSL failed to properly interpret its own insurance contract in attempting to redefine Ms. G’s actual occupation.   In addition, RSL grossly misrepresented a telephone conversation with Ms. G during the review process.  Our office also submitted supportive opinions from Ms. G’s treating physician and a Functional Abilities Evaluation, supporting the reasons why Ms. G could not perform the duties of her occupation. 

After reviewing our appeal, RSL agreed our client was in fact still “disabled” according to the terms of the long term disability insurance policy and reinstated her benefits.  If your claim for long-term disability benefits has been denied or terminated, we may be able to assist you as well.  Our office has handled hundreds of long term disability insurance appeals.  Please contact McDermott Law, LLC for assistance in submitting a thorough, comprehensive appeal.  

 

Categories: Blogs, Disability, Long-Term Disability Benefits

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